Admission criteria to the Danish Brain Cancer Program are moderately associated with magnetic resonance imaging findings
|
|
- Geoffrey Griffin
- 5 years ago
- Views:
Transcription
1 Dan Med J 60/3 March 2013 danish medical JOURNAL 1 Admission criteria to the Danish Brain Cancer Program are moderately associated with magnetic resonance imaging findings Thomas Winther Hill, Mie Kiszka Nielsen & Jørgen Nepper-Rasmussen ABSTRACT INTRODUCTION: The objective of this study was to evaluate the Danish Brain Cancer Program by examining the criteria for admission to the program and the results of magnetic resonance imaging (MRI) of the brain in 359 patients referred to the program at the Odense University Hospital during one year. The admission criteria given by the Danish Health and Medicines Authority are as follows: 1. Prior computed tomography or MRI indicating tumour. 2. Progressive focal neurological deficits. 3. Epileptic seizure in adults. 4. Change in behaviour or cognition showing progression. 5. Headache with progression over 3-4 weeks. MATERIAL AND METHODS: This was a retrospective analysis of the cerebral MRI of 359 patients. The patients were categorized by admission criteria and MRI outcome. The findings were grouped into four main outcomes: 1. Primary malignant intracerebral tumour. 2. Intracranial tumour (including meningeoma and metastasis). 3. Acute pathology in total (including tumours and other acute pathologies). 4. Findings of no consequence. RESULTS: We found 46 acute/subacute pathologies including 21 tumours of which eight were primary intracerebral malignant tumours and 313 scans did not have findings of any consequence. In the group with monosymptomatic headache, we found significantly fewer tumours (p = , Fisher s exact test) and acute pathologies (p = ) than in the remaining groups. In the group with change in behaviour or cognition, we found significantly more primary intracerebral malignant tumours (p = ), tumours in all (p = ) and acute pathologies (p = ) than in the other groups. CONCLUSION: Fewer tumours than expected were found. Significantly fewer pathologies were found in the group with monosymptomatic headache than in the remaining groups. FUNDING: not relevant. TRIAL REGISTRATION: not relevant. The Danish Brain Cancer Program was established in The program refers to a well-defined set of events and procedures during the diagnostic work-up as well as the maximum duration of the diagnostic work-up in patients suspected of having a brain tumour. The admission criteria to the Brain Cancer Program are divided into five categories [1] as presented in Table 1. At Odense University Hospital (OUH), the program is set up so that the referring physician, usually the patient s general practitioner, calls the Neurology Department. The Neurology Department then provides the indication for inclusion into the Brain Cancer Program if relevant. A magnetic resonance imaging (MRI) is performed within 48 hours. The day after the scan, the patient is seen in the neurological outpatient clinic for follow-up/mri results. It was expected that approx. 10,000 patients nation wide would be included in the Brain Cancer Program, of which approx. 1,000 patients were expected annually to have either a malignant or a benign intracranial tumour [1, 2]. At the Department of Radiology, OUH, 359 patients were referred for MRI via the program from 1 February 2011 to 31 January At the department, we had the impression that relatively few of the patients had a primary brain tumour, but also that many patients had other relevant pathologies. We also had the impression that some of the reference categories yielded far fewer positive findings than others. Table 1 Inclusion criteria of the Danish Brain Cancer Program. 1. Computed tomography or magnetic resonance imaging (performed on other indications) showing an intracranial process 2. New onset focal neurologic symptoms (e.g. hemiplegia, sensory disturbance, visual field defect or aphasia) progressing over days/ weeks with no other plausible explanation, such as subdural haematoma or multiple sclerosis 3. New onset epileptic seizures in adults with no other plausible explanation, such as sleep deprivation or drug addiction 4. New onset of behavioural/personality change or cognitive deficits progressing over weeks/few months with no other plausible explanation such as known dementia, psychiatric disorder or drug addiction 5. New onset headache or significant change in prior headache pattern progressive over 3-4 weeks, and where a thorough medical history and physical examination by a neurologist has not revealed other plausible explanations, such as prior trauma, sinusitis or drug addiction Original article Department of Diagnostic Radiology, Odense University Hospital Dan Med J 2013;60(3):A4580
2 2 danish medical JOURNAL Dan Med J 60/3 March 2013 MATERIAL AND METHODS We performed a retrospective analysis on data from the patients referred via the Danish Brain Cancer Program in the period from 1 February 2011 to 31 January A total of 364 patients were identified of whom 359 were included. The five patients who were excluded had a previously known cancer and had been referred on suspicion of metastases. Included patients were characterized by age, sex, referral reason(s) and MRI findings. The referral reasons were divided into the five aforementioned criteria and a sixth category (named other ) in case none of the five criteria were present. Where the reference cause was unclear, we reviewed relevant medical records. In all cases, a reference cause was found, although in several instances the case had to be assigned to the other category. Data were then collected, and MRI findings were divided into four main categories: Table 2 Age and findings. The purpose of this paper was to quantify the number of primary malignant brain tumours, the total number of intracranial tumours and other relevant pathology. Furthermore, we wanted to quantify the distribution of findings in relation to the five aforementioned reference criteria. All (n = 359) Primary malignant intracerebral tumour (n = 8) All tumours (n = 21) Acute og subacute pathology (n = 46) Findings of no consequence (n = 313) Men, n Average age (SD), years Median age, years SD = standard deviation ( ) Patient from Danish Brain Cancer Program with left-sided glioblastoma ( ) 62.7 ( ) 63.7 ( ) ( ) 1. Primary malignant intracerebral tumour. 2. All tumors : This category included the primary malignant intracerebral tumours as well as meningioma, pituitary tumours, extracranial tumours and metastases. 3. All acute and subacute pathology : This category consisted of categories 1 and 2 as well as acute haemorrhages, acute infarction, acute multiple sclerosis (MS), subdural haematoma (SDH) and other acute and subacute findings. The pathologies in this group were chosen based on the consideration that they represent differential diagnoses to tumours and/or is an indication for the MRI outside the Brain Cancer Program. 4. Findings of no consequence. This group consisted of findings that did not require treatment such as old infarctions, atrophy, sinusitis and normal findings. In the cases where the MRI diagnosis was uncertain and in all cases with tumours, the relevant patient records were reviewed to achieve a definitive diagnosis. Subsequently, data were analyzed in relation to reference category, age and gender. For the statistical calculations, Fisher s exact test was used. Trial registration: not relevant. RESULTS A total of 359 patients were included in this study. Of these, 21 had MRI-verified tumour, eight of which were primary malignant intracerebral tumours, five were meningiomas, three were pituitary tumours, four were metastases in patients without known primary cancer and one was an extracerebral tumour. In all, 25 patients had other acute or subacute pathology: three haemorrhages, 11 acute infarctions, one SDH, one acute MS, nine subacute MS (e.g. chronic SDH) and three others. Out of these 25 patients, three patients had two acute or subacute diagnoses. A total of 313 patients had no acute or subacute diagnoses. The average age of the 359 patients was 47.5 years. The distribution in relation to radiological findings is shown in Table 2. There were 153 men and 206 women. Two men and six women had a primary malignant intracerebral tumour. A total of nine men and 12 women had a tumour, while 25 men and 21 women had acute or subacute pathology.
3 Dan Med J 60/3 March 2013 danish medical JOURNAL 3 When grouped by referral reason, we found 11 patients referred after other imaging, 68 with neurological deficits, 100 with epilepsy, 48 with Beha v- i oral, Personality or Cognitive Deficits (BPCD), 145 with headache and 53 in the group other. A total of 48 patients each had two reference reasons and nine patients had three or more reference reasons each. Among the patients who were referred with only one indication, we found three of the other imaging group, 34 with neurological deficits, 91 with epilepsy, 16 with BPCD and 105 with monosymptomatic headache. As shown in Table 3, we observed that out of the eight primary malignant intracerebral tumours, two were referred with monosymptomatic epilepsy, three with monosymptomatic BPCD, two had two indications and one had three or more indications. Six out of the eight had BPCD as one of their referral reasons. The 46 cases with acute/subacute pathology, including the 21 with tumours, were widely distributed on the various referral reasons, as seen in Table 3. Ten tumours and 15 with acute/subacute pathology had BPCD as one of their referral reasons. Statistically, two of the referral groups stand out: monosymptomatic headache and BPCD. There were significantly fewer tumours in the group with monosymptomatic headache (p = ) than overall. There were also significantly fewer acute/subacute diagnoses (p = ). Regarding primary brain tumours in the group referred with headaches, there was no basis for statistical significance due to the low overall number of primary intracerebral tumours. We found significantly more primary intracerebral tumours (p = ), all tumors (p = ) and acute/subacute pathology (p = ) in the BPCD group than in the total group. The average age in the group was considerably higher than in the whole group: 57.9 years (53.3 to 62.4) versus 47.5 years (45.5 to 49.5). DISCUSSION In this paper, we examined a population of 359 patients referred for MRI via the Danish Brain Cancer Program to the Radiology Department, OUH. We found a total of 21 tumours, including eight primary malignant intracerebral tumours, five meningiomas, three pituitary tumours, four metastases in patients without known primary cancer and one extracranial tumour. Moreover, another 25 patients had intracranial pathology, where MRI may have been a relevant examination, although it did not necessarily have to be performed within 48 hours. In a report published by the Danish Health and Medicines Authority in 2009 regarding the Brain Cancer Program, it was expected that the program would reveal a brain tumour (including meningiomas and others) in approx. 10% of the referred patients [1, 2]. In the present study, Table 3 Referral reason and findings. The values are n. Indication All referrals in the category Primary malignant intracerebral tumour All intracranial tumours Acute/subacute pathology, incl. tumour Monosymptomatic Prior CT/MRI Neurological deficits Epilepsy BPCD Headache Other indications indications Total BPCD = Behavioral, Personality or Cognitive Deficits; CT = computed tomography; MRI = magnetic resonance imaging. this figure is somewhat lower, namely 5.8%. The difference may, in part, be due to the fact that a total of 53 patients were referred even though they did not belong to one of the five reference groups identified in the Brain Cancer Program. However, in this sixth group (named the other group), we found one patient with an intracerebral tumour, which was not a significantly lower share than that observed for the whole group. Even if we excluded this group from the examination, we would still detect less than 7% positive findings. The group referred with monosymptomatic headache had significantly fewer tumours, as well as significantly fewer acute and subacute pathologies. This group is relatively large (105 patients), and if we were to exclude this group as well as the sixth group, we would reach the expected pecentage of approx. 10% tumours. A literature review shows that 25-77% of all patients with primary brain tumours and metastases have headache as one of their symptoms [3-5]. There are few reports of monosymptomatic headache as a symptom of brain tumour one study found that approx. 8% of brain tumour patients [4] had monosymptomatic headache. These studies were all performed on material consisting of patients with previously known intracerebral tumours. Our study differs in that the patients had no known tumour at the time of inclusion. Large studies have shown that headache is very frequent, with a lifetime prevalence of up to 99%, and that approx. 4% of the population has chronic headache, defined as more than 15 headache days per month [6, 7]. Some of those who experience chronic headache would fulfill criterion 5 of the Brain Cancer Program, but to scan that many patients would be impossible. When, as in our study, there are so few positive findings in the group referred with monosymptomatic headache, we should consider
4 4 danish medical JOURNAL Dan Med J 60/3 March 2013 whether these patients should even be included in the Brain Cancer Program, especially when considering the high amount of resources this program demands. Another group that stands out in our study is the group with BPCD. This group has significantly more primary malignant tumors, a higher total number of tumours and acute/subacute pathologies than other groups. However, the age composition of this group was higher than that observed in the other groups except the group referred after prior CT or MRI. Numerous studies have shown that brain tumours are more frequent in the elderly [3, 8]. Other studies have shown that 23-90% patients with an intracerebral tumour have at least one symptom belonging to our BPCD group [3, 9]. In our study, we found two patients with primary intracerebral tumor in the group with mono-symptomatic epilepsy. Studies have shown that 10-15% of epilepsy in adults is due to underlying tumour [10-12] and that monosymptomatic epilepsy in brain tumour patients is mostly found in the young [13]. We found that 57 of 359 patients fulfilled two or more of the reference criteria. Despite this, there were not significantly more pathological findings in these patients. This is probably due to the low number of patients in our study. None of the three patients referred on the basis of prior MRI/CT with a suspected tumour but without fulfilling any of the other referral criteria had a primary malignant brain tumour. Furthermore, we found 53 patients who did not meet the criteria of the program. This relatively high number may be due to ignorance of the exact wording of the Brain Cancer Program, especially regarding the headache category, where many of the referred patients had only a few days prior history of headache and not the three-week minimum stipulated in the guidelines. In several cases, we had the impression that the patient s fear of a tumour had been instrumental in motivating the physician towards referral. At the OUH, the patient is not seen by a specialist in neurology before the scan, but is instead consulted via telephone by the neurologist. This procedure was chosen based on the consideration that a prior neurologic consultation is unlikely to reduce the number of scans considerably; it cannot, however, be ruled out that some patients might not have had the MRI performed if an examination had been done, but the examination in itself would probably not be more cost-effective than the scan. Two recent studies published in the Danish Medical Journal [14, 15] found 139 tumours in 241 referred patients, whereas we found 21 tumours in 359 patients referred under the Brain Cancer Program. A total of 139 tumours in 241 patients is a surprisingly large number of positive findings considering the expectations from the Danish Board of Health; and the results of these two studies do not match our results. Their method differs from ours in that they included patients with tumours detected on prior scans (81 patients) and in that nearly all of these patients were included retrospectively, i.e. after the tumour diagnosis. They were divided into the four clinical referral categories based on a questionnaire and a neurological examination where the examiner knew the result of the scan a priori. At the Neurology Department of the OUH, patients diagnosed with brain tumour on a prior scan skip the first steps in the Brain Cancer Program and go straight to the Neurosurgery Department. Apart from 11 cases, all patients in our study were referred from their GP, whereas this was the case in only 49% in the two other studies. The 21 patients with tumours found in our study are thus the direct result of the Brain Cancer Program. CONCLUSION In relation to the publication from the Danish Health and Medicines Authority from 2009, we found fewer brain tumours than the expected approx. 10%. We found only eight primary malignant tumours (approx. 2%) and a total of 21 tumours including meningiomas, metastases and primary tumours (approx. 6%). At the same time, our study showed that there were significantly fewer findings in the group referred on the indication of headache alone. We question whether this indication should remain part of the Brain Cancer Program. Not surprisingly, we found that high age was significant in relation to findings of pathology of any kind, which may partly explain why there were significantly more tumours in the group with BPCD which also had a more advanced age profile. Additionally, 53 patients did not meet the referral criteria. This indicates a need to heighten awareness of the specifics of the referral criteria of the Danish Brain Cancer Program. CORRESPONDENCE: Thomas Winther Hill, Kløvervænget 22, 5000 Odense C, Denmark. thomaswintherhill@hotmail.com ACCEPTED: 5 December 2012 CONFLICTS OF INTEREST: None. Disclosure forms provided by the authors are available with the full text of this article at LITERATURE 1. Pakkeforløb for kræft i hjernen. København: Sundhedsstyrelsen, Dansk Neuro Onkologisk Gruppe. Retningslinjer for behandling af intrakranielle gliomer hos voksne. DNOG, Chang S, Parney I, Huang W et al. Patterns of care for adults with newly diagnosed malignant glioma. JAMA 2005;293: Vázquez-Barquero A, Ibáñez FJ, Herrera S et al. Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalagia 1994:I4: Sreenvasa R, Chandana M, Movva S et al. Primary brain tumors in adults. Am Fam Phys 2008;77: Rasmussen BK, Jensen R, Schroll M et al. Epidemiology of headache in a general population a prevalence study. J Clin Epidemiol 1991;44:
5 Dan Med J 60/3 March 2013 danish medical JOURNAL 5 7. Scher A, Stewart WF, Liberman J et al. Prevalence of frequent headache in a population sample. Headache 1998;38: Radhakrishnan K, Mokri B, Parisi JE et al. The trends in incidence of primary brain tumors in the population of Rochester, Minnesota. Ann Neurol 1995;37: Tucha O, Smely C, Preier M et al. Cognitive deficits before treatment among patients with brain tumors. Neurosurg 2000;47: Bromfield EB. Epilepsy in patients with brain tumors and other cancers. Rev Nerol Dis 2004; 1(Suppl 1):S27-S Ibrahim K, Appleton R. Seizures as the presenting symptom of brain tumours in children. Seizure 2004;13: Lynam LM, Lyons MK, Drazkowski JF et al. Frequency of seizures in patients with newly diagnosed brain tumors: A retrospective review. Clin Neurol Neurosurg 2007;109: Liigant A, Haldre S, Õun A et al. Seizure disorders in patients with brain tumors. Eur Neurol 2001;45: Laursen EL, Rasmussen BK. A brain cancer pathway in clinical practice. Dan Med J 2012;59(5):A Laursen EL, Rasmussen BK. Work-up times in an integrated brain cancer pathway. Dan Med J 2012;59(5):A4438.
PRACTICAL NEUROLOGY. Reversible. dementias Blackwell Science Ltd
138 PRACTICAL NEUROLOGY Reversible dementias JUNE 2002 139 Gunhild Waldemar Memory Disorders Research Unit, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, 9 Blegdamsvej, DK-2100
More informationStroke Mimics. Paul Guyler
Stroke Mimics Paul Guyler Consultant Stroke Physician at Southend University Hospital Clinical Lead for Acute Stroke Essex Cardiac and Stroke Network Aims Why worry? Stroke Recognition Tools History, Examination
More informationBrief Clinical Report: Recognizing Subdural Hemorrhage in Older Adults
Research Brief Clinical Report: Recognizing Subdural Hemorrhage in Older Adults Mark T. Pfefer, RN, MS, DC *1 ; Richard Strunk MS, DC 2 Address: 1 Professor and Director of Research, Cleveland Chiropractic
More informationFORM ID. Patient's Personal Details. SECTION A : Medical Record of the Patient. Name. Policy Number. NRIC/Old IC/Passport/Birth Cert/Others
CRITICAL ILLNESS CLAIM - DOCTOR'S STATEMENT Brain and Nerve Related Conditions Note: This form is to be completed at the Patient s expense by the Attending Physician/ Surgeon who treated the patient. Patient's
More informationIschemic Stroke in Critically Ill Patients with Malignancy
Ischemic Stroke in Critically Ill Patients with Malignancy Jeong-Am Ryu 1, Oh Young Bang 2, Daesang Lee 1, Jinkyeong Park 1, Jeong Hoon Yang 1, Gee Young Suh 1, Joongbum Cho 1, Chi Ryang Chung 1, Chi-Min
More informationAttending Physician Statement- Benign Brain Tumour or Subdural Haematoma
Instruction to doctor: This patient is insured with us against the happening of certain contingent events associated with his health. A claim has been submitted in connection with Benign Brain Tumour or
More informationSeizure Disorders. Guidelines for assessment of fitness to work as Cabin Crew
Seizure Disorders Guidelines for assessment of fitness to work as Cabin Crew General Considerations As with all medical guidelines, it is important that each individual case is assessed on its own merits.
More informationEpilepsy after two different neurosurgical approaches
Journal ofneurology, Neurosurgery, and Psychiatry, 1976, 39, 1052-1056 Epilepsy after two different neurosurgical approaches to the treatment of ruptured intracranial aneurysm R. J. CABRAL, T. T. KING,
More informationExperience from two decades of the Cambridge Rapid Access Neurology Clinic
Clinical Medicine 2015 Vol 15, No 5: 437 41 ORIGINAL RESEARCH Experience from two decades of the Cambridge Rapid Access Neurology Clinic Authors: Laura T Axinte, A Barnaby D Fiddes, B Alastair Donaghy,
More informationATTENDING PHYSICIAN'S STATEMENT BENIGN BRAIN TUMOUR / SURGICAL REMOVAL OF PITUITARY TUMOUR OR SURGERY FOR SUBDURAL HAEMATOMA
ATTENDING PHYSICIAN'S STATEMENT BENIGN BRAIN TUMOUR / SURGICAL REMOVAL OF PITUITARY TUMOUR OR SURGERY FOR SUBDURAL HAEMATOMA A) Patient s Particulars Name of Patient NRIC/FIN or Passport No. Date of Birth
More informationBrain audit at Thames Valley
Thames Valley Cancer Strategic Clinical Network Brain audit at Thames Valley Thames Valley Strategic Clinical Network Summary The brain referral tumour audit and data collection was carried out in Thames
More informationAn analysis of MRI findings in patients referred with fits
An analysis of MRI findings in patients referred with fits Pallewatte AS 1, Alahakoon S 1, Senanayake G 1, Bulathsinghela BC 1 1 National Hospital of Sri Lanka, Colombo, Sri Lanka Abstract Introduction:
More informationBrain and Central Nervous System Cancers
Brain and Central Nervous System Cancers NICE guidance link: https://www.nice.org.uk/guidance/ta121 Clinical presentation of brain tumours History and Examination Consider immediate referral Management
More informationNON MALIGNANT BRAIN TUMOURS Facilitator. Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol
NON MALIGNANT BRAIN TUMOURS Facilitator Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol Neurosurgery What will be covered? Meningioma Vestibular schwannoma (acoustic neuroma)
More informationSubspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level
Subspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level Prerequisites: Any prior pediatric rotations and experience Primary Goals for this
More informationLate Onset Shake-Etiology At Stake - A Prospective Study
Original Article Late Onset Shake-Etiology At Stake - A Prospective Study G Sendil 1, Arun N Kumar 1, Mohan V Kumar 2 1 Senior Resident, ESIC PGIMSR & MH, Bangalore, 2 Consultant Physician Columbia Asia
More informationPREVALENCE BY HEADACHE TYPE
CLINICAL CLUES AND CLINICAL RULES: PRIMARY VS SECONDARY HEADACHE * Based on a presentation by David W. Dodick, MD ABSTRACT Headache is a common condition, accounting for many specialist office visits annually.
More informationOccurrence and Risk Factors for Post-traumatic Epilepsy in Civilian Poulations December 2, 2012
Occurrence and Risk Factors for Post-traumatic Epilepsy in Civilian Poulations December 2, 2012 Dale C Hesdorffer, PhD GH Sergievsky Center Columbia University American Epilepsy Society Annual Meeting
More informationSymptoms and problems in the End of Life Phase of High Grade Glioma Patients
Chapter 2.1 Symptoms and problems in the End of Life Phase of High Grade Glioma Patients Eefje M. Sizoo Lies Braam Tjeerd J. Postma H. Roeline W. Pasman Jan J. Heimans Martin Klein Jaap C. Reijneveld Martin
More informationProvide specific counseling to parents and patients with neurological disorders, addressing:
Neurology Description: The Pediatric Neurology elective will give the resident the opportunity to learn how to obtain an appropriate history and perform a complete neurologic exam. Four to five half days
More informationATTENDING PHYSICIAN'S STATEMENT STROKE / BRAIN ANEURYSM SURGERY OR CEREBRAL SHUNT INSERTION / CAROTID ARTERY SURGERY
ATTENDING PHYSICIAN'S STATEMENT STROKE / BRAIN ANEURYSM SURGERY OR CEREBRAL SHUNT INSERTION / CAROTID ARTERY SURGERY A) Patient s Particulars Name of Patient Gender NRIC/FIN or Passport No. Date of Birth
More informationNeuroimaging for dementia diagnosis. Guidance from the London Dementia Clinical Network
Neuroimaging for dementia diagnosis Guidance from the London Dementia Clinical Network Authors Dr Stephen Orleans-Foli Consultant Psychiatrist, West London Mental Health NHS Trust Dr Jeremy Isaacs Consultant
More informationHemorrhagic infarction due to transverse sinus thrombosis mimicking cerebral abscesses
ISPUB.COM The Internet Journal of Neurosurgery Volume 5 Number 2 Hemorrhagic infarction due to transverse sinus thrombosis mimicking cerebral abscesses N Barua, M Bradley, N Patel Citation N Barua, M Bradley,
More informationAdult Neurology Residency Training Program McGill University Objectives of Training and Training Requirements. For Outpatient Neurology Clinics
Neurology Residency Program Department of Neurology & Neurosurgery Postal address: Montreal Neurological Institute 3801 University Street Montreal, PQ, Canada H3A 2B4 Tel.: (514) 398-1904 Fax: (514) 398-4621
More informationSupplementary Online Content
Supplementary Online Content Wolters FJ, Li L, Gutnikov SA, Mehta Z, Rothwell PM. Medical attention seeking after transient ischemic attack and minor stroke in relation to the UK Face, Arm, Speech, Time
More informationThe University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology
The University of Arizona Pediatric Residency Program Primary Goals for Rotation Neurology 1. GOAL: Understand the role of the pediatrician in preventing neurological diseases, and in counseling and screening
More informationTHE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION. Mustafa Rashid Issa
THE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION Mustafa Rashid Issa ABSTRACT: Illustrate malignant tumors that form either in the brain or in the nerves originating in the brain.
More informationProspective Study of Adult Onset Seizure
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 4 Ver. V (April. 2017), PP 46-50 www.iosrjournals.org Prospective Study of Adult Onset Seizure
More informationJUSTIFICATION PROTOCOLS FOR CT SCANNING ALBURY WODONGA HEALTH WODONGA CAMPUS
JUSTIFICATION PROTOCOLS FOR CT SCANNING ALBURY WODONGA HEALTH WODONGA CAMPUS JUSTIFICATION PROTOCOLS FOR CT SCANNING INTRODUCTION: In accordance with the Victorian Radiation Act 2005 Wodonga Medical Imaging,
More informationMeningioma The Sarawak General Hospital Experience
ORIGI.NAL ARTICLE Meningioma The Sarawak General Hospital Experience S H Wong, FRACS, S H Chan, MBBS Hospital Umum Sarawak, Jalan Tun Ahmad Zaidi Adruce, Kuching, 986 Sarawak Introduction Meningioma is
More informationStroke in the ED. Dr. William Whiteley. Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian
Stroke in the ED Dr. William Whiteley Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian 2016 RCP Guideline for Stroke RCP guidelines for acute ischaemic stroke
More informationEpidemiology of primary tumours of the brain and
Journal of Neurology, Neurosurgery, and Psychiatry, 1976, 39, 290-296 Epidemiology of primary tumours of the brain and spinal cord: a regional survey in southern England D. J. P. BARKER, R. 0. WELLER,
More informationMANAGEMENT N OF PRIMARY BRAIN TUMOURS IN THE ELDERLY
MANAGEMENT N OF PRIMARY BRAIN TUMOURS IN THE ELDERLY Meningioma, Glioma, Lymphoma Cornu Ph, Keime-Guibert F, Hoang-Xuan K, Pierga JY, Delattre JY Neuro-oncology Group of Pitie-Salpetriere hospital-paris-france
More informationDr Eddie Mee. Neurosurgeon Auckland City Hospital, Ascot Integrated Hospital, MercyAscot Hospitals, Auckland
Dr Eddie Mee Neurosurgeon Auckland City Hospital, Ascot Integrated Hospital, MercyAscot Hospitals, Auckland 16:30-17:25 WS #48: Current Management of Brain Bleeds and Tumours 17:35-18:30 WS #58: Current
More informationa. Ischemic stroke An acute focal infarction of the brain or retina (and does not include anterior ischemic optic neuropathy (AION)).
12.0 Outcomes 12.1 Definitions 12.1.1 Neurologic Outcome Events a. Ischemic stroke An acute focal infarction of the brain or retina (and does not include anterior ischemic optic neuropathy (AION)). Criteria:
More informationRedgrave JN, Coutts SB, Schulz UG et al. Systematic review of associations between the presence of acute ischemic lesions on
6. Imaging in TIA 6.1 What type of brain imaging should be used in suspected TIA? 6.2 Which patients with suspected TIA should be referred for urgent brain imaging? Evidence Tables IMAG1: After TIA/minor
More informationNEURORADIOLOGY Part I
NEURORADIOLOGY Part I Vörös Erika University of Szeged Department of Radiology SZEGED DISEASES OF CNS BRAIN Developmental anomalies Cerebrovascular disorders Tumours Inflammatory diseases Trauma DISEASES
More informationEVALUATION OF CHRONIC HEADACHE BY COMPUTED TOMOGRAPHY: A RETROSPECTIVE STUDY
EVALUATION OF CHRONIC HEADACHE BY COMPUTED TOMOGRAPHY: A RETROSPECTIVE STUDY Abstract: Anish Subedee Objective: To find out the proportion of intracranial abnormalities in patients with chronic headache
More informationLOSS OF CONSCIOUSNESS & ASSESSMENT. Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT
LOSS OF CONSCIOUSNESS & ASSESSMENT Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT OUTLINE Causes Head Injury Clinical Features Complications Rapid Assessment Glasgow Coma Scale Classification
More informationClinical indications for positron emission tomography
Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will
More informationHealth Learning Partnership 13 th September Neuroimaging. Headache Dementia Incidentalomas DR MARCUS BRADLEY CONSULTANT NEURORADIOLOGIST
Health Learning Partnership 13 th September 2017 Neuroimaging DR MARCUS BRADLEY CONSULTANT NEURORADIOLOGIST Headache Dementia Incidentalomas Dr Marcus Bradley Consultant Neuroradiologist Interventional
More informationX-Plain Brain Cancer Reference Summary
X-Plain Brain Cancer Reference Summary Introduction Brain tumors are not rare. About 20,000 Americans are diagnosed with brain cancer or related cancer of the nervous system. This reference summary will
More informationNeurology. Access Center 24/7 access for referring physicians (866) 353-KIDS (5437)
Neurology The Neurology practice at Valley Children s provides diagnostic services, medical treatment, and followup care to infants, children, and adolescents who have suspected or confirmed neurological
More informationACR Appropriateness Criteria Suspected Lower Extremity Deep Vein Thrombosis EVIDENCE TABLE
. Fowkes FJ, Price JF, Fowkes FG. Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur J Vasc Endovasc Surg 003; 5():-5.. Hamper UM, DeJong MR, Scoutt LM. Ultrasound
More informationChild Neurology Elective PL1 Rotation
PL1 Rotation The neurology elective is available to first year residents in either a 2 or 4 week block rotation. The experience will include performing inpatient consultations, attending outpatient clinics
More informationOriginal Article Evaluation of Diagnostic Value of CT Scan and MRI in Brain Tumors and Comparison with Biopsy
Original Article Evaluation of Diagnostic Value of CT Scan and MRI in Brain Tumors and Comparison with Biopsy Taghipour Zahir SH MD 1, Rezaei sadrabadi M MD 2, Dehghani F MD 3 1- Department of Clinical
More informationDr Isobel Salter, Dr Sara Ali, Dr Jasavanth Basavaraju, Dr Hemalata Bentur, Dr Maysara Abdelaziz
Dr Isobel Salter, Dr Sara Ali, Dr Jasavanth Basavaraju, Dr Hemalata Bentur, Dr Maysara Abdelaziz Whiston Hospital, Liverpool, UK EAP Congress 2015, Oslo The nature of epilepsy means that it can be difficult
More informationPatterns of Care and Outcomes After Computed Tomography Scans for Headache
CLINICAL RESEARCH STUDY Patterns of Care and Outcomes After Computed Tomography Scans for Headache John J. You, MD, MSc, a,b Jonathan Gladstone, MD, c,d Sean Symons, MD, MPH, e,f Dalia Rotstein, MD, g
More informationCNS SSCRG Work Programme
National Brain Tumour Registry CNS SSCRG Work Programme Incidence, Mortality and Survival Analysis Produced by NBTR 2012 Area Measure Subjects Year of diagnosis England Persons Cases per Year England Male
More informationImaging for suspected glioma
Imaging for suspected glioma 1.1.1 Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected glioma, unless
More informationYour experiences. It s all in the brain? Deciphering Neurological Presentations a Perspective From Neuropsychiatry
Your experiences Deciphering Neurological Presentations a Perspective From Neuropsychiatry Mike Dilley Maudsley Hospital michael.dilley@slam.nhs.uk Think about the last patient that your saw with a neurological
More informationThere are several types of epilepsy. Each of them have different causes, symptoms and treatment.
1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic
More informationrecommendations of the Royal College of
Archives of Emergency Medicine, 1993, 10, 138-144 Skull X-ray after head injury: the recommendations of the Royal College of Surgeons Working Party Report in practice R. E. MACLAREN, H. I. GHOORAHOO &
More informationLothian Audit of the Treatment of Cerebral Haemorrhage (LATCH)
1. INTRODUCTION Stroke physicians, emergency department doctors, and neurologists are often unsure about which patients they should refer for neurosurgical intervention. Early neurosurgical evacuation
More informationDiagnosing Epilepsy in Children and Adolescents
2019 Annual Epilepsy Pediatric Patient Care Conference Diagnosing Epilepsy in Children and Adolescents Korwyn Williams, MD, PhD Staff Epileptologist, BNI at PCH Clinical Assistant Professor, Department
More informationSpecialised Services Policy: CP22. Stereotactic Radiosurgery
Specialised Services Policy: CP22 Document Author: Assistant Director of Planning Executive Lead: Director of Planning ad Performance Approved by: Management Group Issue Date: 01 July 2015 Review Date:
More informationRadiology. General radiology department. X-ray
The radiology directorate provides a diagnostic, interventional and therapeutic service for its local population, and a tertiary service for the region. It also provides support to some national work such
More informationSeizures in high-grade glioma patients:
Seizures in high-grade glioma patients: a serious challenge in the end of life phase JAF Koekkoek,* EM Sizoo,* TJ Postma, JJ Heimans, HRW Pasman, L Deliens, MJB Taphoorn and JC Reijneveld BMJ Support Palliat
More informationUTILIZATION MANAGEMENT POLICY AND PROCEDURE MANUAL
University of Florida, Pediatric Integrated Care System UTILIZATION MANAGEMENT POLICY AND PROCEDURE MANUAL Policy: Program(s): Approval Criteria for Neuroimaging of Headaches Title XIX and Title XXI Effective
More informationBrainwave The Irish Epilepsy Association
249 Crumlin Road Dublin 12 Tel: 01-4557500 Email: info@epilepsy.ie Web: www.epilepsy.ie AUTISTIC SPECTRUM DISORDER (ASD) AND EPILEPSY Rates of epilepsy among children and adults with autism may be higher
More informationStereotactic Biopsy of Brain Tumours
Stereotactic Biopsy of Brain Tumours Pages with reference to book, From 176 To 178 Shahzad Shams, Rizwan Masood Butt, Afaq Sarwar ( Department of Neurosurgery Unit 1, Lahore General Hospital, Lahore. )
More informationIctal pain: occurrence, clinical features, and underlying etiologies.
Thomas Jefferson University Jefferson Digital Commons Department of Neurology Faculty Papers Department of Neurology 8-1-2016 Ictal pain: occurrence, clinical features, and underlying etiologies. Ali Akbar
More informationHIROSHI NAKAGUCHI, M.D., PH.D., TAKEO TANISHIMA, M.D., PH.D., Clinical Material and Methods
J Neurosurg 93:791 795, 2000 Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage HIROSHI NAKAGUCHI,
More informationAcute subdural hematoma as a complication of diagnostic lumbar puncture: case report
Romanian Neurosurgery Volume XXX Number 4 2016 October - December Article Acute subdural hematoma as a complication of diagnostic lumbar puncture: case report Luis Rafael Moscote-Salazar 1, Andres M. Rubiano
More informationOriginal Article. Emergency Department Evaluation of Ventricular Shunt Malfunction. Is the Shunt Series Really Necessary? Raymond Pitetti, MD, MPH
Original Article Emergency Department Evaluation of Ventricular Shunt Malfunction Is the Shunt Series Really Necessary? Raymond Pitetti, MD, MPH Objective: The malfunction of a ventricular shunt is one
More informationOriginal Research Article
MAGNETIC RESONANCE IMAGING IN MIDDLE CEREBRAL ARTERY INFARCT AND ITS CORRELATION WITH FUNCTIONAL RECOVERY Neethu Tressa Jose 1, Rajan Padinharoot 2, Vadakooth Raman Rajendran 3, Geetha Panarkandy 4 1Junior
More informationTransarterial Embolisation of Cerebral Arteriovenous Malformations
Transarterial Embolisation of Cerebral Arteriovenous Malformations How Few Can You Do? G. WIKHOLM, C. LUNDQVIST*, P. SVENDSEN Section of Interventional Neuroradiology, Department of Radiology, * Department
More informationReferral Criteria for Medical CT Radiation Exposures. Neuro Referrals
Referral Criteria for Medical CT Radiation Exposures Neuro Referrals CHH & HRI The Ionising Radiation (Medical Exposure) Regulations 2017 Document Control Reference No: 3.2 First published: 2016 Version:
More informationOriginal Article. Evaluation of The Role and Utility of Neuroimaging In New Onset Seizures Presenting To The Emergency Department
Original Article Evaluation of The Role and Utility of Neuroimaging In New Onset Seizures Presenting To The Emergency Department Lalit Kumar 1, Vipin Kumar 2, Hardeep Singh Gill 3 *, G Avasthi 4, Gagandeep
More informationLong-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety
Neuroradiology (2011) 53:343 348 DOI 10.1007/s00234-010-0726-1 INTERVENTIONAL NEURORADIOLOGY Long-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety Sandra P. Ferns
More informationThe Value of a Chest CT in the Evaluation of a Newly Detected Brain Tumor
Southern Adventist Univeristy KnowledgeExchange@Southern Senior Research Projects Southern Scholars 1999 The Value of a Chest CT in the Evaluation of a Newly Detected Brain Tumor Jennifer L. White John
More informationAn Introduction to Imaging the Brain. Dr Amy Davis
An Introduction to Imaging the Brain Dr Amy Davis Common reasons for imaging: Clinical scenarios: - Trauma (NICE guidelines) - Stroke - Tumours - Seizure - Neurological degeneration memory, motor dysfunction,
More informationAndrzej Żyluk 1, Agnieszka Mazur 1, Bernard Piotuch 1, Krzysztof Safranow 2
POLSKI PRZEGLĄD CHIRURGICZNY 2013, 85, 12, 699 705 10.2478/pjs-2013-0107 Analysis of the reliability of clinical examination in predicting traumatic cerebral lesions and skull fractures in patients with
More informationMEDIA BACKGROUNDER. Multiple Sclerosis: A serious and unpredictable neurological disease
MEDIA BACKGROUNDER Multiple Sclerosis: A serious and unpredictable neurological disease Multiple sclerosis (MS) is a complex chronic inflammatory disease of the central nervous system (CNS) that still
More information/ / / / / / Hospital Abstraction: Stroke/TIA. Participant ID: Hospital Code: Multi-Ethnic Study of Atherosclerosis
Multi-Ethnic Study of Atherosclerosis Participant ID: Hospital Code: Hospital Abstraction: Stroke/TIA History and Hospital Record 1. Was the participant hospitalized as an immediate consequence of this
More informationIntroduction. Abstract. Michael Yannes 1, Jennifer V. Frabizzio, MD 1, and Qaisar A. Shah, MD 1 1
Reversal of CT hypodensity after acute ischemic stroke Michael Yannes 1, Jennifer V. Frabizzio, MD 1, and Qaisar A. Shah, MD 1 1 Abington Memorial Hospital in Abington, Pennsylvania Abstract We report
More informationRecommendations. for Care of Adults with Epilepsy. Seeking the best treatment from the right doctor at the right time!
Recommendations for Care of Adults with Epilepsy Seeking the best treatment from the right doctor at the right time! Contents This booklet is to help adults and their caregivers know when it is appropriate
More informationTitle: Quality of life in childhood epilepsy with lateralized focus
Author's response to reviews Title: Quality of life in childhood epilepsy with lateralized focus Authors: Krystyna A. Mathiak (krystyna.mathiak@psych.uw.edu.pl) Malgorzata Luba (malgosia.luba@gmail.com)
More informationAttending Physician Statement- Stroke
Instruction to doctor: This patient is insured with us against the happening of certain contingent events associated with his health A claim has been submitted in connection with Stroke / Intracranial
More informationNational follow-up program CPUP Pediatric Neurology paper form
National follow-up program CPUP Pediatric Neurology paper form 110206 1 National Follow-Up program- CPUP Pediatric Neurology Personal nr (unique identifier): Last name: First name: Region child belongs
More informationOverview 12/8/2008. Simplifying Neurology for critical illness claims. Multiple Sclerosis. Basics Advances in diagnosis and treatment.
Simplifying Neurology for critical illness claims Jeremy Hobart Consultant Neurologist and Senior Lecturer Peninsula College of Medicine and Dentistry Cheltenham 04 December 2008 Overview Multiple Sclerosis
More informationSupratentorial cerebral arteriovenous malformations : a clinical analysis
Original article: Supratentorial cerebral arteriovenous malformations : a clinical analysis Dr. Rajneesh Gour 1, Dr. S. N. Ghosh 2, Dr. Sumit Deb 3 1Dept.Of Surgery,Chirayu Medical College & Research Centre,
More informationNeuroimaging in Migraine Critically Appraised Topic (CAT)
Neuroimaging in Migraine Critically Appraised Topic (CAT) PICOT Question: Does a head CT scan compared to no head CT scan change the management of a child with migraine? Clinical bottom line based on literature
More informationDanish Three-Legged Strategy for Early Diagnosis - an integrating approach
Danish Three-Legged Strategy for Early Diagnosis - an integrating approach Peter Vedsted Professor, Director Lower 1-year survival in Denmark Local stage for breast or lung cancer % lung cancer in local
More informationPatient characteristics. Intervention Comparison Length of followup. Outcome measures. Number of patients. Evidence level.
5.0 Rapid recognition of symptoms and diagnosis 5.1. Pre-hospital health professional checklists for the prompt recognition of symptoms of TIA and stroke Evidence Tables ASM1: What is the accuracy of a
More informationSupplementary material 1. Definitions of study endpoints (extracted from the Endpoint Validation Committee Charter) 1.
Rationale, design, and baseline characteristics of the SIGNIFY trial: a randomized, double-blind, placebo-controlled trial of ivabradine in patients with stable coronary artery disease without clinical
More informationAnton-Babinski syndrome as a rare complication of chronic bilateral subdural hematomas
DOI: 10.2478/romneu-2018-0050 Article Anton-Babinski syndrome as a rare complication of chronic bilateral subdural hematomas D. Adam, D. Iftimie, Cristiana Moisescu, Gina Burduşa ROMANIA Romanian Neurosurgery
More informationORIGINAL CONTRIBUTION
ORIGINAL CONTRIBUTION Common Misdiagnosis of a Common Neurological Disorder How Are We Misdiagnosing Essential Tremor? Samay Jain, MD; Steven E. Lo, MD; Elan D. Louis, MD, MS Background: As a common neurological
More informationPrevalence and Distribution of Neurological Disease in a Neurology Clinic in Enugu, Nigeria
Prevalence and Distribution of Neurological Disease in a Neurology Clinic in Enugu, Nigeria Onwuekwe IO* and Ezeala-Adikaibe B* *Neurology Unit, Department of Medicine, University of Nigeria Teaching Hospital,
More informationPRACTICE PARAMETER: NEUROIMAGING IN THE EMERGENCY PATIENT PRESENTING WITH SEIZURE. (Summary Statement)
PRACTICE PARAMETER: NEUROIMAGING IN THE EMERGENCY PATIENT PRESENTING WITH SEIZURE (Summary Statement) Report of the Quality Standards Subcommittee of the American Academy of Neurology in cooperation with
More informationWatch and wait (active monitoring)
Watch and wait (active monitoring) When you re diagnosed with a brain tumour, you may expect to have immediate treatment, possibly involving surgery and/or radiotherapy and chemotherapy. However, with
More informationPrevalence of headache in an elderly population: attack frequency, disability, and use of medication
J Neurol Neurosurg Psychiatry 2001;70:377 381 377 Department of Neurological Sciences, La Sapienza University, Via dell Amba Aradam 21, 00184 Rome Rome, Italy M Prencipe A R Casini C Ferretti M Santini
More informationA common case definition for PML
A common case definition for PML Transatlantic workshop: Drug-related Progressive Multifocal Leukoencephalopathy (PML) 25.-26.7.2011, EMA, London Paul-Ehrlich-Institut Dr. Dirk Mentzer, MD Paul-Ehrlich-Str.
More informationNeurosurgical Management of Brain Tumours. Nicholas Little Neurosurgeon RNSH
Neurosurgical Management of Brain Tumours Nicholas Little Neurosurgeon RNSH General Most common tumours are metastatic 10x more common than primary Incidence of primary neoplasms is 20 per 100000 per year
More informationThe central nervous system
Sectc.qxd 29/06/99 09:42 Page 81 Section C The central nervous system CNS haemorrhage Subarachnoid haemorrhage Cerebral infarction Brain atrophy Ring enhancing lesions MRI of the pituitary Multiple sclerosis
More informationMolecular Imaging and the Brain
Molecular imaging technologies are playing an important role in neuroimaging, a branch of medical imaging, by providing a window into the living brain. Where CT and conventional MR imaging provide important
More informationPATIENTS WITH MULTIPLE SCLEROSIS
3 PATIENTS WITH MULTIPLE SCLEROSIS PREFER EARLY DIAGNOSIS Abstract The new diagnostic criteria for multiple sclerosis (MS) allow for a definite diagnosis in earlier stages of disease. Yet, clinicians may
More informationClinical, radiological, and histopathological features and prognostic factors of brain tumors in children
Journal of Physics: Conference Series PAPER OPEN ACCESS Clinical, radiological, and histopathological features and prognostic factors of brain tumors in children To cite this article: M H Siregar et al
More information